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BMC Med Educ. 2017 Oct 6;17(1):182. doi: 10.1186/s12909-017-1020-2.

A novel bedside cardiopulmonary physical diagnosis curriculum for internal medicine postgraduate training.

Author information

1
Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, 1830 East Monument Street, Baltimore, MD, 21287, USA. bgariba1@jhmi.edu.
2
Department of Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, USA.
3
Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Baltimore, MD, 21224, USA.
4
Division of Cardiology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, USA.
5
Department of General Internal Medicine, 2024 E Monument St, Baltimore, MD, 21205, USA.
6
Department of Surgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, USA.
7
Division of Nephrology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, USA.
8
Division of Geriatric Medicine, Johns Hopkins University School of Medicine, 5200 Eastern Avenue 7th Floor, Baltimore, MD, 21224, USA.
9
Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, 1830 East Monument Street, Baltimore, MD, 21287, USA.

Abstract

BACKGROUND:

Physicians spend less time at the bedside in the modern hospital setting which has contributed to a decline in physical diagnosis, and in particular, cardiopulmonary examination skills. This trend may be a source of diagnostic error and threatens to erode the patient-physician relationship. We created a new bedside cardiopulmonary physical diagnosis curriculum and assessed its effects on post-graduate year-1 (PGY-1; interns) attitudes, confidence and skill.

METHODS:

One hundred five internal medicine interns in a large U.S. internal medicine residency program participated in the Advancing Bedside Cardiopulmonary Examination Skills (ACE) curriculum while rotating on a general medicine inpatient service between 2015 and 2017. Teaching sessions included exam demonstrations using healthy volunteers and real patients, imaging didactics, computer learning/high-fidelity simulation, and bedside teaching with experienced clinicians. Primary outcomes were attitudes, confidence and skill in the cardiopulmonary physical exam as determined by a self-assessment survey, and a validated online cardiovascular examination (CE).

RESULTS:

Interns who participated in ACE (ACE interns) by mid-year more strongly agreed they had received adequate training in the cardiopulmonary exam compared with non-ACE interns. ACE interns were more confident than non-ACE interns in performing a cardiac exam, assessing the jugular venous pressure, distinguishing 'a' from 'v' waves, and classifying systolic murmurs as crescendo-decrescendo or holosystolic. Only ACE interns had a significant improvement in score on the mid-year CE.

CONCLUSIONS:

A comprehensive bedside cardiopulmonary physical diagnosis curriculum improved trainee attitudes, confidence and skill in the cardiopulmonary examination. These results provide an opportunity to re-examine the way physical examination is taught and assessed in residency training programs.

KEYWORDS:

Bedside medicine; Cardiopulmonary exam; Medical education; Physical examination skills

PMID:
28985729
DOI:
10.1186/s12909-017-1020-2
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